Post Space Flight

1
Post Space Flight Rapid Sequence Induction
Anesthetic Induction Protocol
Hal Doerr, MD
2
Anesthesia and Space Medicine

• Since the post-anesthetic death of a monkey
• during the Bion Satellite Primate Experiments
• there have been concerns about the safety of
• the use of General Anesthesia in humans
• Immediately Post Space Flight.

3
Anesthesia and Space Medicine

• 1995-1996 Combined Russian/American program to
  assess the physiologic consequences of space
  flight was conducted
• Large group of monkeys were trained on a variety
  of tasks for eight months
• 22 monkeys were selected for 11 low earth orbit
  flights of 14 days each

4
Anesthesia and Space Medicine

• First 10 pairs received anesthesia on post flight
  days 2 and 3 to retrieve implanted monitors,
  obtain biopsies and measure bone density
• Eleventh pair received anesthesia on post flight
  day one
• All animals received Ketamine and Isoflurane
• Eleventh pair one death and the other had
  significant anesthetic complications

5
Anesthesia and Space Medicine

• Questions raised
• Can anesthesia be given safely to astronauts in
  the immediate post flight period?
• Does exposure to micro gravity alter the
  physiologic effects of anesthetics?
• How long after flight is it safe to administer
  anesthesia?

6
Space Medicine Working Group

• Dr David Williams
• physician-astronaut, head of Space and Life
  Sciences Directorate
• Dr Norman E. McSwain
• Dept of Surgery, Tulane University
• Dr Sam Pool
• Deputy Director, Space and Life Sciences
• Launched 3 year effort
• Multi-disciplinary teams
• Surgery
• Anesthesia
• Emergency Medicine
• Integrated basic science data, operational
  records, Patient Condition Database
• Now we could script HPS simulations!

7
Space Medicine Working Group Anesthesiology

• Dr David Williams
• Dr Norman E. McSwain
• Dr Sam Pool
• Hal Doerr ,MD
• Paul Barasch, MD
• William Norfleet, MD

8

• September 2002
• Medical Operations Support Team
• Supports activities of Space Medicine Health
  Care Systems

9
Why No Medical Simulation?

• NASA Primary Focus Mission Objectives
• Satellite launches
• ISS construction
• Materials research
• Basic science
• Medical events Off-Nominal
• Life Sciences Research ? Health Care Integration
• Laboratory vs. Clinical
• Bone vs. Kidney Research
• Lack of Physiological Data

10
Terrestrial Correlate

• 47 Year old previously healthy male
• Bedridden in ICU X 5 months
• Right heart failure
• Catecholamine depleted
• Paraplegic

11
Space Physiology

• Neuro-Vestibular
• Vestibular
• Space Motion Sickness
• Neuro-Vascular
• Dehydration
• Decreased Red Cell Mass
• Autonomics
• Baroceptors
• 3rd Spacing

• Neuro-Muscular
• Atrophy
• Rhabdomyolysis
• Capacitance Vessels
• Skeletal
• Bone Loss
• Renal
• Increased Ca Loads
• Gastrointestinal
• Nausea
• Vomiting

12
Space Physiology

• Pharmacodynamics
• Automaticity
• Catecholamine depletion?
• Volume of Distribution
• Drug Delivery
• Drug Half-Lives
• Radiation Effects

13
Off Nominal LandingSIMULATION

• Soyuz landing following 5 month mission
• Normal scheduled reentry (end of mission)
• Nominal/Ballistic reentry with hard impact
• Seat separation
• 47 year old Male Astronaut
• Negative- PMH, PSH, Anes Hx, NKDA
• Transitional phase 0G ? 1G

14
Patient Profile

• Following seat separation upon impact, thrown
  forward into instrument panel

15
Patient Profile

• Exam
• Extensive facial contusions, hemorrhage
• Crepitus over nasolabial third of right
  Zygomatic arch
• Significant Epistaxis
• Severe right peri-orbital swelling and contusions

16
Patient Profile

• Exam
• L pupil round, reactive to light, 4mm
• R pupil round, fixed, 6mm
• LOC waxing/waning
• No other injuries apparent

17
Decision Point

• Stand and fight?
• Limited supplies on site
• Patient may improve (or may not)
• Scoop and run?
• Ramstein/Landstuhl 9 hr by rotor fixed wing
  transport
• Treatments?
• Bolt?
• Drain Hematoma?
• Stabilize Bone Fragment?

18
Anesthesia Protocol

• Pre-Op
• Induction
• Maintenance
• Emergence

19
Anesthesia and Space Medicine

• Previous Post Flight RSI Anesthesia Protocol
• Standard RSI protocol
• Etomidate 0.3 mg/kg (std. 0.2-0.6 mg/kg)
• Succinylcholine 1.5 mg/kg (std. 0.3-1.1mg/kg)
• Pavulon 0.015 mg/kg (std. 0.8-.12 mg/kg)

20
Anesthesia and Space Medicine

• Previous Post Flight RSI Anesthesia Protocol
• Head trauma
• Lidocaine 1.5 mg/kg
• Pavulon 0.1 mg/kg (Defasiculating dose)
• Etomidate 0.25-0.5 mg/kg (std. 0.2-0.6 mg/kg)
• Succinylcholine 1.5 mg/kg (std. 0.3-1.1mg/kg)

21
Anesthesia and Space Medicine

• Current Post Flight RSI Anesthesia Protocol
• Standard RSI protocol
• Etomidate 0.3 mg/kg (std. 0.2-0.6 mg/kg)
• Rocuronium 0.6-1.2 mg/kg

22
Anesthetic Considerations

• NMBs
• Inhaled anesthetics
• BZDs
• Hypnotics
• Beta blockers
• Direct vs indirect agonists
• Pressors
• Fluids
• Code drugs

23
Questions?